- Email: [email protected]
Progress Report on the Effect of a Fissure Sealant on Bacteria in Dental Caries
Progress report on the effect of a fissure sealant on bacteria in dental caries
A
s ig n if ic a n t d e c r e a s e in th e n u m b e r o f c u lt iv a
b le
m ic r o o r g a n is m s
fro m
in f e c t e d
d e n t in
has
b e e n r e p o r t e d a t o n e m o n t h a f t e r s e a lin g o f t h e o c c lu s a l
p it s
and
f is s u r e s
o f p e rm a n e n t
w it h
a n u lt r a v io le t - lig h t - p o ly m e r iz e d
T h is
re p o rt
p re se n ts
r e s u lt s f o r p a t ie n t s
a d d it io n a l
e x a m in e d u p
te e th
a d h e s iv e .1
b a c t e r io lo g ic a l to
s ix
m o n th s
a ft e r a s in g le a p p lic a t io n o f t h e a d h e s iv e .
S . L. H andelm an, DMD
Material and methods
M. G. Buonocore, MS, DMD P. C. Schoute, Tandarts, Rochester, NY
P a t ie n t s
w e re
e ra l c lin ic
s e le c t e d
o f th e
fro m
E a stm a n
o f th e
gen
D e n ta l C e n te r.
th o se
The
c r it e r ia f o r s e le c t io n o f t e e th in t h is s t u d y w e r e :
Teeth in which caries had penetrated the pits and fissures were sealed with an ultraviolet-light-poly
a d e f in it e
merized adhesive. Sam ples of carious dentin from both experimental and contralateral control teeth were taken one, two, four, and six months after the sealant had been placed. After six months, the
p it
number of microorganism s from the dentin of sealed teeth was substantially lower than that from the dentin of control teeth.
le s io n
in
a p it
o r f is s u r e
th a t w o u ld
c a t c h a n d h o ld a n e x p lo r e r t in e ; a n in t a c t e n a m e l su rfa c e , and
o th e r th a n
f is s u r e ,
th e
w it h o u t
decayed
c lin ic a l
are a
o f th e
e v id e n c e
of a
b r e a k o f m o r e t h a n 1 m m in e a c h d ir e c t io n la t e r a l to th e lo n g a x is o f th e f is s u r e ; r a d io g r a p h ic e v i d e n c e o f c a r ie s p e n e t r a t io n o f n o t m o r e t h a n h a lf th e
d e n t in ;
no
r a d io g r a p h ic
e v id e n c e
o f c a r ie s
p e n e t r a t io n in t o t h e d e n t in o n t h e p r o x im a l s u r f a c e ; n o c lin ic a l e v id e n c e o f c a r ie s o n t h e b u c c a l o r lin g u a l s u r f a c e s ; a n d n o p r e v io u s r e s t o r a t io n s . C o n t r o l t e e t h w e r e s e le c t e d , a s f a r a s p o s s ib le , fro m
th e c o n t r a la t e r a l s id e s o f th e m o u th . T h e
to o th
w it h
th e m o re
advanced
le s io n
w as used
a s th e e x p e r im e n t a l to o th . Th e
m e t h o d s f o r s e a lin g t h e p it s a n d f is s u r e s
w e re
th e
sam e
c o r e 2’3 f o r
as
th o se
n o n c a r io u s
d e s c r ib e d
te e th .
Th e
by te e th
Buono to
be
s e a le d w e r e c le a n e d w it h a n a ir a n d w a t e r s p r a y , is o la t e d b y
c o tto n
r o lls
o r r u b b e r d a m , a n d a ir
d r ie d . I n t h e p r e p a r a t io n o f t h e e n a m e l f o r b o n d in g , a c id
a
c o n d it io n in g
c o n t a in in g
7%
s o lu t io n
(5 0 %
d is s o lv e d
z in c
p h o s p h o r ic o x id e
by
w e ig h t ) w a s a p p lie d t o t h e o c c lu s a l s u r f a c e s . A
JADA, Vol. 87, November 1973 ■ 1189
c o tto n
p le d g e t s a t u r a t e d
ru b b e d
o v e r th e
w it h
su rfa c e
m in u t e ; t h e n t h e c a v it y
th e
o f th e
s o lu t io n
c a v it y
fo r
w as
w e re
one
a lu m in u m
w a s g e n t ly w a s h e d a n d
im m e d ia t e ly
c lo s e d
w it h
a
s lig h t ly
s h e ll to m in im iz e d r y in g . T h e
la r g e r s a m p le
w a s t h e n r e w e ig h e d , a n d t h e s a m p le w e ig h t w a s
a ir d r ie d . T h e a d h e s iv e c o n t a in e d t h r e e p a r t s b y
d e t e r m in e d
w e ig h t o f t h e
m in a t io n o f it s w e ig h t , t h e s a m p le a n d t h e g e la
r e a c t io n
p r o d u c t o f b is p h e n o l A
by
th e
d if fe r e n c e .
A fte r
th e
d e te r
a n d g l y c i d y l m e t h a c r y la t e a n d o n e p a r t b y w e ig h t
t in c a p s u le w e r e p la c e d i n b r o t h (1 m g o f s a m p le
o f m e t h a c r y la t e m o n o m e r in w h ic h a p p r o x im a t e
p e r m illilit e r o f b r o t h ) in
ly
c o n t a i n i n g a s t e r i l e g l a s s p o w d e r o f 6 0 / i. m
2%
b e n z o in m e t h y l e th e r h a d b e e n d is s o lv e d
a s a n u lt r a v io le t - lig h t - s e n s it iv e a p p lie d
w it h
c a t a ly s t .
a c a m e l’ s h a ir b r u s h
It
w as
to a fe a th e r-
t ic le
s iz e
s a m p le
e d g e o n to t h e c u s p in c lin e a n d c o v e r e d a ll c r e v
t ic le s
ic e s
fro m
as
w e ll a s
th e
A f t e r a p p lic a t io n
decayed
to
th e
p it s
to o th
and
f is s u r e s .
su rfa c e ,
th e
ad
o r s m a lle r .
w e re
w e re
t is s u e
B o th
th e
h o m o g e n iz e d
p re se n t.
th e u n s e a le d
u n t il n o
S a m p le s
th e
v is ib le
o f c a r io u s d ilu t e d
p a r
d e n t in to
1 0 -4,
t h e s e a le d le s io n s w e r e
d ilu t e d
to t h e r a y s o f a lo n g - w a v e u lt r a v io le t lig h t (3 ,6 6 0
r ie d o u t o n a m o d ifie d B a ir d - P a r k e r m e d iu m f o r
A n g s tro m s ).
fo u r d a y s
o b se rve d
r a d io g r a p h ic a lly
p la c e m e n t a fte r th e
and
in
som e
p la c e m e n t
im m e d ia t e ly
in s t a n c e s
o f th e
b it e w in g s w e r e t a k e n w it h a n X C P A
s ix
s e a la n t .
at 37 C
of 95%
in
in s t r u m e n t .* at 65
kv
th e t o t a l v ia b le s e a le d
le s io n s
s e a le d
le s io n s
co u n t, and
w e re
by
w it h
t
once, b y
11 p a i r s
13 p a ir s
e n v ir o n m e n t
D e n ta l C e n te r
p ro ce sso r,
in
an
a tm o
ca rb o n
d io x
o f m ic r o a e r o p h ilic a n d a n a e r o b ic c o n d it io n s o n
duced
u s e o f a n a u t o m a t ic f ilm
5%
ca r
m o n th s
p h ilic
E a stm a n
and
w as
id e .4 I n a d d it io n , f o r a c o m p a r is o n o f th e e ffe c ts
w as
a t th e
B re w e r s ja r s
h yd ro g e n
a n d 10 m a . P r o c e s s in g o f a ll c lin ic a l r a d io g r a p h s done
1 0 '4 . C u l t i v a t i o n
b e fo re
L o n g -c o n e
R it t e r r a d io g r a p h ic u n it t w a s u s e d
sp h e re
1 0 '3 ,
p a r
and
h e s iv e w a s h a r d e n e d b y a o n e -m in u t e e x p o s u r e
T e e t h to b e s e a le d a n d th e c o n t r o l t e e th w e r e
1 0 ‘2 ,
h o m o g e n iz e r
c a p s u le
le s io n s w e r e
1 0 '5 , 1 0 ' 6 . S a m p l e s f r o m to
a
o f c o u n ts fro m
o f c o u n ts fro m
co m p a re d . (a b o u t
0 .5 %
e v a c u a t io n
o f th e
n o t f lu s h in g
w it h
A
un
m ic r o a e r o
O 2)
w as
p ro
B re w e r s ja r s
o n ly
H 2, a n d
by
n o t re
E x p e r im e n t a l a n d c o n tr o l te e th w e re g r o u p e d
m o v in g t h e r e s id u a l o x y g e n w it h a p la t in u m e le c
in t h r e e c a t e g o r ie s a c c o r d in g to t h e d e p t h o f t h e
t r o d e . T h e p la t e s w e r e c o u n t e d u s in g a Q u e b e c
c a r io u s
c o lo n y c o u n t e r .
le s io n
as
e s t im a t e d
r a d io g r a p h ic a lly :
s lig h t p e n e t r a t io n o f t o o t h s t r u c t u r e , m o r e t h a n s lig h t p e n e t r a t io n u p
to
a fo u rth
o f th e
d e n t in ,
a n d p e n e t r a t io n o f m o r e t h a n a f o u r t h t o h a lf o f t h e d e n t in . T h ir t y - t h r e e r io lo g ic
te e th
w e re
s a m p le d
e x a m in a t io n
one,
tw o ,
fo r
fo u r,
Results
b a c te -
and
s ix
Th e
in t e g r it y
t y - s ix m a t c h e d t e e th th a t w e r e n o t s e a le d s e r v e d
and
th e y
a s c o n tr o l te e th .
Th e
r a d io g r a p h s o f te e th
p le d b a c t e r io lo g ic a lly w e r e is o la t e d
w it h
w as
checked
Im m e d ia t e ly b e fo r e
v is u a lly
w it h
an
e x p lo r e r .
t u r e o f io d in e a n d w it h 7 0 % e x t e n d in g ju s t
in t o
a lc o h o l. A
th e
d e n t in
t in c
C la s s
b u r in
a
be
w it h
so u n d
in
e x p e r im e n t a l an
e x p lo r e r ,
a ll in s t a n c e s .
s e a le d f o r s ix
th e
p r e o p e r a t iv e
m o n th s r a d io -
Table 1 ■The effect of fissure sealant on the number
of bacteria in carious dentin for various time intervals (nx104/mg of dentin).
w as
h ig h -s p e e d
h a n d p ie c e .
p re
A n
Unsealed teeth 0 mo
1
p a r e d in t h e c o n v e n t io n a l m a n n e r w it h a s t e r ile f is s u r e
co m p a re d
to
th e w it h
s a m p lin g , th e o c c lu s a l s u r
f a c e o f t h e t o o th w a s d is in f e c t e d w it h 7 %
c a v it y
seem ed
in
checked
a ru b
b e r d a m a n d a i r d r ie d . T h e in t e g r it y o f t h e s e a le d te e th
w e re
v is u a lly
s e a ls
m o n t h s a f t e r t h e s e a la n t h a d b e e n p la c e d . T w e n -
E x p e r im e n t a l a n d c o n tr o l te e th th a t w e r e s a m
w as
o f th e
te e th
No. 26 Av 108.9 95% confidence interval ± 54.8
Sealed teeth 1 mo
2 mo
4 mo
6 mo
10 4.7
10 2.9
6 1.0
7 0.4
± 6 .3
±4 .0
± 1 .4
± 0 .7
a ir
s p r a y w a s u s e d d u r in g th e f ir s t p a r t o f th e s t u d y , b u t s u b s e q u e n t ly a w a t e r a n d a ir s p r a y w a s u s e d . A
s t e r iliz e d
s p o o n e x c a v a t o r w a s u s e d to re
m o v e a b o u t 1 m g o f c a r io u s d e n t in . E a c h s a m p le w a s d e p o s it e d in th e lo w e r p a r t o f a p r e w e ig h e d g e la t in c a p s u le h e ld in a n o u t e r a lu m in u m Th e
c a p s u le s
p re ve n t 1190
w e re
h e ld
c o n t a m in a t io n .
w it h Th e
■ JADA, Vol. 87, November 1973
p la s t ic c a p s u le
s h e ll.
g lo v e s and
to
s h e ll
Table 2 ■ Comparison of paired microaerophilic and
anaerobic counts for sealed and unsealed lesions (nx104/mg carious dentin). Lesions Sealed (n = 11) Unsealed (n = 13)
M icroaerophilic
Anaerobic
2.27 ±2.07* 122.5 ± 149.1
4.49 ±6.25 124.0±102.6
'N in e ty -fiv e percent confidence level.
Table 3 ■Comparison of total viable counts (nx104/mg of carious dentin) in relation to the depth of the carious lesion. Slight
More than slight and up to a fourth
More than a fourth and up to half Unsealed
Unsealed
Sealed*
Unsealed
Sealed*
5 96.0 ±145.1
11 0.44 ± 0 .6 3
6 14.8 ±18.3
6 0.44 ±0.81
No. Mean 95% confidence interval
Sealed 7 1.68 ±1.68
6 191.7 ±224.0
*One count, which was ten tim es higher than the average count, was elim inated in the final averaging of the data for th is Table, but was included in the tabulation of the data fo r Table 1.
g r a p h s . T h e c a r io u s le s io n s d id n o t s e e m to h a v e p r o g r e s s e d , b u t t h e lim it e d n u m b e r o f t e e th s a m p le d
fo r
th a t
p e r io d
p r e c lu d e s
a n y t h in g
m o re Th e
t h a n a s t a t e m e n t o f c lin ic a l im p r e s s io n . Th e
r e d u c t io n in th e t o t a l v ia b le c o u n t o f in
fe c te d
d e n t in
in c r e a s e d
w it h
a n t w a s in p la c e ( T a b le m o n th , tw o
m o n th s, a n d 20, 40, and
th e
end
3 0 0 -f o ld
o f s ix
d e cre a se
N o
w it h
th e
s e a l
fo u r m o n th s
w as
ap
10 0 f o ld , r e s p e c t iv e ly .
m o n th s, th e re w a s in
th e
m ic r o o r g a n is m s fr o m co m p a re d
as
1 ). T h e r e d u c t io n a t o n e
p r o x im a t e ly A t
t im e
num ber
a lm o s t a
o f c u lt iv a b le
t h e d e n t in o f s e a le d t e e th
th a t o f u n s e a le d
c o n tr o l te e th .
s ig n if ic a n t d if fe r e n c e s w e re f o u n d b e t w e e n
r e p lic a t e
d ilu t io n s
a e r o b ic a lly
and
of
s a m p le s
in c u b a t e d
m ic r o a e r o p h ic a lly
Discussion and conclusion
fro m
an
s e a le d
r e s u lt s o f t h e
c o n fir m w h ic h
th e r e s u lt s it w a s
s ix : m o n th
stu d y
e xte n d
o f th e p r e lim in a r y
c o n je c t u r e d
c ip ie n t o r m o d e r a t e ly
and
s t u d y in
th a t tre a tm e n t o f in
advanced
c a r ie s
w it h
an
o c c lu s a l s e a la n t m a y r e t a r d o r p r e v e n t t h e p r o g re s s o f d e c a y , o r b o th . Th e
d e m o n s t r a t io n
th a t
s e a lin g
o f c a r ie s
in
p it s a n d f is s u r e s is a s a fe a n d b e n e f ic ia l p r o c e d u r e w o u ld e x t e n d th e c lin ic a l u s e f u ln e s s o f a d h e s iv e s
in
are a s
o th e r
th a n
p r e v e n t io n .
H o w
e v e r , b e f o r e t h is is a c c e p t e d a s a r o u t in e p r o c e d u r e , lo n g - t e r m b a c t e r io lo g ic
c lin ic a l s t u d ie s
e v a lu a t io n ,
as
w it h
w e ll a s
a d d it io n a l s t u d ie s
to
th e m e a n c o u n t
d e t e r m in e p o s s ib le c h a n g e s in t h e d e n t in , s h o u ld
f r o m s e a le d le s io n s in c u b a t e d a n a e r o b ic a lly t e n d
b e d o n e . S e a lin g o f c a r io u s p it s a n d f is s u r e s in
e d to b e h ig h e r ( T a b le 2 ).
th e
a n d u n s e a le d le s io n s , a lt h o u g h
T h e p e n e t r a t io n o f t h e c a r io u s le s io n in t o d e n
d e c id u o u s
d e n t it io n
s h o u ld
a ls o
be
e v a l
u a te d .
t in , w it h in t h e p a r a m e t e r s o f th e s t u d y , d id n o t seem
to
v ia b le Th e
s ig n if ic a n t ly
c o u n t fro m
co u n ts
fro m
e ff e c t th e r e m a in in g
th e th e
s e a le d
le s io n
u n s e a le d
to ta l
(T a b le
le s io n s in
3 ).
te e th
w it h a p e n e t r a t io n o f b e t w e e n a f o u r t h t o a h a lf o f t h e d e n t in t e n d e d to b e h ig h e r t h a n t h e t o t a l v ia b le c o u n t f r o m le s io n s in te e th w it h le s s c a r ie s p e n e t r a t io n , b u t t h e r e s u lt s w e r e n o t s ig n if ic a n t s t a t is t ic a lly . Th e
d a ta
o f th e p r e lim in a r y
s tu d y 1 w e re
in
c lu d e d in t h e r e s u lt s o f t h is s t u d y . T h e o n ly d if f e r e n c e in th e m e th o d s o f p r o c e d u r e f o r th e m o re r e c e n t f in d in g s sp ra y
d u r in g
w a s th e u s e
th e
o f a w a te r a n d
in it ia l c a v it y
p r e p a r a t io n ,
a ir in
s t e a d o f a h a n d p i e c e w i t h o u t t h e w a t e r s p r a y . 1,5 Th e
to ta l
num ber
of
o r g a n is m s
c u lt u r e d
fro m
u n s e a le d c a r io u s le s io n s w it h w a t e r a n d a ir s p r a y (n = 1 7 ,
1 0 . 1 x l 0 5/ m g o f c a r i o u s
d e n t in ) w a s e s
s e n t ia lly t h e s a m e a s th e n u m b e r c u lt u r e d w it h o u t th e w a te r s p ra y (n = 9 , o u s d e n t in ). O n r e s u lt s
o f b o th
c o m b in e d .
1 2 . 4 x l 0 5/ m g o f c a r i
t h is b a s is , w e t h o u g h t th a t th e p o r t io n s
o f th e
stu d y
c o u ld
be
The authors wish to thank Mrs. Wilma Schwarze for her ex cellent laboratory assistance. Dr. Handelman is head of the general clinic and director of the internship program, Dr. Buonocore is research coordinator, and Dr. Schoute was an intern at the Eastman Dental Center, Rochester, NY 14603. * Rinn Co., Elgin, 60120. t Ritter Co., Rochester, NY 14611. i S. S. White Div., Pennwalt Corp., Philadelphia, 19102. 1. Handelman, S.L.; Buonocore, M.G.; and Hesek, D.J. A pre liminary report on the effect of fissure sealant on bacteria in den tal caries. J Prosthet Dent 27:390 April 1972. 2. Buonocore, M.G. Adhesive sealing of pits and fissures for caries prevention, with use of ultraviolet light. JADA 80:324 Feb 1970. 3. Buonocore, M.G. Caries prevention in pits and fissures sealed with an adhesive resin polymerized by ultraviolet light: a two-year study of a single adhesive application. JADA 82:1090 May 1971. 4. Handelman, S.L., and Hess, C. Bacterial populations of se lected tooth surface sites. J Dent Res 48:67 Jan-Feb 1969. 5. King, J.B., Jr.; Crawford, J.J.; and Lindahl, R.L. Indirect pulp capping: a bacteriologic study of deep carious dentine in human teeth. Oral Surg 20:663 Nov 1965.
Handelman—Buonocore—Schoute: EFFECT OF FISSURE SEALANT ON BACTERIA ■
1191
A
s ig n if ic a n t d e c r e a s e in th e n u m b e r o f c u lt iv a
b le
m ic r o o r g a n is m s
fro m
in f e c t e d
d e n t in
has
b e e n r e p o r t e d a t o n e m o n t h a f t e r s e a lin g o f t h e o c c lu s a l
p it s
and
f is s u r e s
o f p e rm a n e n t
w it h
a n u lt r a v io le t - lig h t - p o ly m e r iz e d
T h is
re p o rt
p re se n ts
r e s u lt s f o r p a t ie n t s
a d d it io n a l
e x a m in e d u p
te e th
a d h e s iv e .1
b a c t e r io lo g ic a l to
s ix
m o n th s
a ft e r a s in g le a p p lic a t io n o f t h e a d h e s iv e .
S . L. H andelm an, DMD
Material and methods
M. G. Buonocore, MS, DMD P. C. Schoute, Tandarts, Rochester, NY
P a t ie n t s
w e re
e ra l c lin ic
s e le c t e d
o f th e
fro m
E a stm a n
o f th e
gen
D e n ta l C e n te r.
th o se
The
c r it e r ia f o r s e le c t io n o f t e e th in t h is s t u d y w e r e :
Teeth in which caries had penetrated the pits and fissures were sealed with an ultraviolet-light-poly
a d e f in it e
merized adhesive. Sam ples of carious dentin from both experimental and contralateral control teeth were taken one, two, four, and six months after the sealant had been placed. After six months, the
p it
number of microorganism s from the dentin of sealed teeth was substantially lower than that from the dentin of control teeth.
le s io n
in
a p it
o r f is s u r e
th a t w o u ld
c a t c h a n d h o ld a n e x p lo r e r t in e ; a n in t a c t e n a m e l su rfa c e , and
o th e r th a n
f is s u r e ,
th e
w it h o u t
decayed
c lin ic a l
are a
o f th e
e v id e n c e
of a
b r e a k o f m o r e t h a n 1 m m in e a c h d ir e c t io n la t e r a l to th e lo n g a x is o f th e f is s u r e ; r a d io g r a p h ic e v i d e n c e o f c a r ie s p e n e t r a t io n o f n o t m o r e t h a n h a lf th e
d e n t in ;
no
r a d io g r a p h ic
e v id e n c e
o f c a r ie s
p e n e t r a t io n in t o t h e d e n t in o n t h e p r o x im a l s u r f a c e ; n o c lin ic a l e v id e n c e o f c a r ie s o n t h e b u c c a l o r lin g u a l s u r f a c e s ; a n d n o p r e v io u s r e s t o r a t io n s . C o n t r o l t e e t h w e r e s e le c t e d , a s f a r a s p o s s ib le , fro m
th e c o n t r a la t e r a l s id e s o f th e m o u th . T h e
to o th
w it h
th e m o re
advanced
le s io n
w as used
a s th e e x p e r im e n t a l to o th . Th e
m e t h o d s f o r s e a lin g t h e p it s a n d f is s u r e s
w e re
th e
sam e
c o r e 2’3 f o r
as
th o se
n o n c a r io u s
d e s c r ib e d
te e th .
Th e
by te e th
Buono to
be
s e a le d w e r e c le a n e d w it h a n a ir a n d w a t e r s p r a y , is o la t e d b y
c o tto n
r o lls
o r r u b b e r d a m , a n d a ir
d r ie d . I n t h e p r e p a r a t io n o f t h e e n a m e l f o r b o n d in g , a c id
a
c o n d it io n in g
c o n t a in in g
7%
s o lu t io n
(5 0 %
d is s o lv e d
z in c
p h o s p h o r ic o x id e
by
w e ig h t ) w a s a p p lie d t o t h e o c c lu s a l s u r f a c e s . A
JADA, Vol. 87, November 1973 ■ 1189
c o tto n
p le d g e t s a t u r a t e d
ru b b e d
o v e r th e
w it h
su rfa c e
m in u t e ; t h e n t h e c a v it y
th e
o f th e
s o lu t io n
c a v it y
fo r
w as
w e re
one
a lu m in u m
w a s g e n t ly w a s h e d a n d
im m e d ia t e ly
c lo s e d
w it h
a
s lig h t ly
s h e ll to m in im iz e d r y in g . T h e
la r g e r s a m p le
w a s t h e n r e w e ig h e d , a n d t h e s a m p le w e ig h t w a s
a ir d r ie d . T h e a d h e s iv e c o n t a in e d t h r e e p a r t s b y
d e t e r m in e d
w e ig h t o f t h e
m in a t io n o f it s w e ig h t , t h e s a m p le a n d t h e g e la
r e a c t io n
p r o d u c t o f b is p h e n o l A
by
th e
d if fe r e n c e .
A fte r
th e
d e te r
a n d g l y c i d y l m e t h a c r y la t e a n d o n e p a r t b y w e ig h t
t in c a p s u le w e r e p la c e d i n b r o t h (1 m g o f s a m p le
o f m e t h a c r y la t e m o n o m e r in w h ic h a p p r o x im a t e
p e r m illilit e r o f b r o t h ) in
ly
c o n t a i n i n g a s t e r i l e g l a s s p o w d e r o f 6 0 / i. m
2%
b e n z o in m e t h y l e th e r h a d b e e n d is s o lv e d
a s a n u lt r a v io le t - lig h t - s e n s it iv e a p p lie d
w it h
c a t a ly s t .
a c a m e l’ s h a ir b r u s h
It
w as
to a fe a th e r-
t ic le
s iz e
s a m p le
e d g e o n to t h e c u s p in c lin e a n d c o v e r e d a ll c r e v
t ic le s
ic e s
fro m
as
w e ll a s
th e
A f t e r a p p lic a t io n
decayed
to
th e
p it s
to o th
and
f is s u r e s .
su rfa c e ,
th e
ad
o r s m a lle r .
w e re
w e re
t is s u e
B o th
th e
h o m o g e n iz e d
p re se n t.
th e u n s e a le d
u n t il n o
S a m p le s
th e
v is ib le
o f c a r io u s d ilu t e d
p a r
d e n t in to
1 0 -4,
t h e s e a le d le s io n s w e r e
d ilu t e d
to t h e r a y s o f a lo n g - w a v e u lt r a v io le t lig h t (3 ,6 6 0
r ie d o u t o n a m o d ifie d B a ir d - P a r k e r m e d iu m f o r
A n g s tro m s ).
fo u r d a y s
o b se rve d
r a d io g r a p h ic a lly
p la c e m e n t a fte r th e
and
in
som e
p la c e m e n t
im m e d ia t e ly
in s t a n c e s
o f th e
b it e w in g s w e r e t a k e n w it h a n X C P A
s ix
s e a la n t .
at 37 C
of 95%
in
in s t r u m e n t .* at 65
kv
th e t o t a l v ia b le s e a le d
le s io n s
s e a le d
le s io n s
co u n t, and
w e re
by
w it h
t
once, b y
11 p a i r s
13 p a ir s
e n v ir o n m e n t
D e n ta l C e n te r
p ro ce sso r,
in
an
a tm o
ca rb o n
d io x
o f m ic r o a e r o p h ilic a n d a n a e r o b ic c o n d it io n s o n
duced
u s e o f a n a u t o m a t ic f ilm
5%
ca r
m o n th s
p h ilic
E a stm a n
and
w as
id e .4 I n a d d it io n , f o r a c o m p a r is o n o f th e e ffe c ts
w as
a t th e
B re w e r s ja r s
h yd ro g e n
a n d 10 m a . P r o c e s s in g o f a ll c lin ic a l r a d io g r a p h s done
1 0 '4 . C u l t i v a t i o n
b e fo re
L o n g -c o n e
R it t e r r a d io g r a p h ic u n it t w a s u s e d
sp h e re
1 0 '3 ,
p a r
and
h e s iv e w a s h a r d e n e d b y a o n e -m in u t e e x p o s u r e
T e e t h to b e s e a le d a n d th e c o n t r o l t e e th w e r e
1 0 ‘2 ,
h o m o g e n iz e r
c a p s u le
le s io n s w e r e
1 0 '5 , 1 0 ' 6 . S a m p l e s f r o m to
a
o f c o u n ts fro m
o f c o u n ts fro m
co m p a re d . (a b o u t
0 .5 %
e v a c u a t io n
o f th e
n o t f lu s h in g
w it h
A
un
m ic r o a e r o
O 2)
w as
p ro
B re w e r s ja r s
o n ly
H 2, a n d
by
n o t re
E x p e r im e n t a l a n d c o n tr o l te e th w e re g r o u p e d
m o v in g t h e r e s id u a l o x y g e n w it h a p la t in u m e le c
in t h r e e c a t e g o r ie s a c c o r d in g to t h e d e p t h o f t h e
t r o d e . T h e p la t e s w e r e c o u n t e d u s in g a Q u e b e c
c a r io u s
c o lo n y c o u n t e r .
le s io n
as
e s t im a t e d
r a d io g r a p h ic a lly :
s lig h t p e n e t r a t io n o f t o o t h s t r u c t u r e , m o r e t h a n s lig h t p e n e t r a t io n u p
to
a fo u rth
o f th e
d e n t in ,
a n d p e n e t r a t io n o f m o r e t h a n a f o u r t h t o h a lf o f t h e d e n t in . T h ir t y - t h r e e r io lo g ic
te e th
w e re
s a m p le d
e x a m in a t io n
one,
tw o ,
fo r
fo u r,
Results
b a c te -
and
s ix
Th e
in t e g r it y
t y - s ix m a t c h e d t e e th th a t w e r e n o t s e a le d s e r v e d
and
th e y
a s c o n tr o l te e th .
Th e
r a d io g r a p h s o f te e th
p le d b a c t e r io lo g ic a lly w e r e is o la t e d
w it h
w as
checked
Im m e d ia t e ly b e fo r e
v is u a lly
w it h
an
e x p lo r e r .
t u r e o f io d in e a n d w it h 7 0 % e x t e n d in g ju s t
in t o
a lc o h o l. A
th e
d e n t in
t in c
C la s s
b u r in
a
be
w it h
so u n d
in
e x p e r im e n t a l an
e x p lo r e r ,
a ll in s t a n c e s .
s e a le d f o r s ix
th e
p r e o p e r a t iv e
m o n th s r a d io -
Table 1 ■The effect of fissure sealant on the number
of bacteria in carious dentin for various time intervals (nx104/mg of dentin).
w as
h ig h -s p e e d
h a n d p ie c e .
p re
A n
Unsealed teeth 0 mo
1
p a r e d in t h e c o n v e n t io n a l m a n n e r w it h a s t e r ile f is s u r e
co m p a re d
to
th e w it h
s a m p lin g , th e o c c lu s a l s u r
f a c e o f t h e t o o th w a s d is in f e c t e d w it h 7 %
c a v it y
seem ed
in
checked
a ru b
b e r d a m a n d a i r d r ie d . T h e in t e g r it y o f t h e s e a le d te e th
w e re
v is u a lly
s e a ls
m o n t h s a f t e r t h e s e a la n t h a d b e e n p la c e d . T w e n -
E x p e r im e n t a l a n d c o n tr o l te e th th a t w e r e s a m
w as
o f th e
te e th
No. 26 Av 108.9 95% confidence interval ± 54.8
Sealed teeth 1 mo
2 mo
4 mo
6 mo
10 4.7
10 2.9
6 1.0
7 0.4
± 6 .3
±4 .0
± 1 .4
± 0 .7
a ir
s p r a y w a s u s e d d u r in g th e f ir s t p a r t o f th e s t u d y , b u t s u b s e q u e n t ly a w a t e r a n d a ir s p r a y w a s u s e d . A
s t e r iliz e d
s p o o n e x c a v a t o r w a s u s e d to re
m o v e a b o u t 1 m g o f c a r io u s d e n t in . E a c h s a m p le w a s d e p o s it e d in th e lo w e r p a r t o f a p r e w e ig h e d g e la t in c a p s u le h e ld in a n o u t e r a lu m in u m Th e
c a p s u le s
p re ve n t 1190
w e re
h e ld
c o n t a m in a t io n .
w it h Th e
■ JADA, Vol. 87, November 1973
p la s t ic c a p s u le
s h e ll.
g lo v e s and
to
s h e ll
Table 2 ■ Comparison of paired microaerophilic and
anaerobic counts for sealed and unsealed lesions (nx104/mg carious dentin). Lesions Sealed (n = 11) Unsealed (n = 13)
M icroaerophilic
Anaerobic
2.27 ±2.07* 122.5 ± 149.1
4.49 ±6.25 124.0±102.6
'N in e ty -fiv e percent confidence level.
Table 3 ■Comparison of total viable counts (nx104/mg of carious dentin) in relation to the depth of the carious lesion. Slight
More than slight and up to a fourth
More than a fourth and up to half Unsealed
Unsealed
Sealed*
Unsealed
Sealed*
5 96.0 ±145.1
11 0.44 ± 0 .6 3
6 14.8 ±18.3
6 0.44 ±0.81
No. Mean 95% confidence interval
Sealed 7 1.68 ±1.68
6 191.7 ±224.0
*One count, which was ten tim es higher than the average count, was elim inated in the final averaging of the data for th is Table, but was included in the tabulation of the data fo r Table 1.
g r a p h s . T h e c a r io u s le s io n s d id n o t s e e m to h a v e p r o g r e s s e d , b u t t h e lim it e d n u m b e r o f t e e th s a m p le d
fo r
th a t
p e r io d
p r e c lu d e s
a n y t h in g
m o re Th e
t h a n a s t a t e m e n t o f c lin ic a l im p r e s s io n . Th e
r e d u c t io n in th e t o t a l v ia b le c o u n t o f in
fe c te d
d e n t in
in c r e a s e d
w it h
a n t w a s in p la c e ( T a b le m o n th , tw o
m o n th s, a n d 20, 40, and
th e
end
3 0 0 -f o ld
o f s ix
d e cre a se
N o
w it h
th e
s e a l
fo u r m o n th s
w as
ap
10 0 f o ld , r e s p e c t iv e ly .
m o n th s, th e re w a s in
th e
m ic r o o r g a n is m s fr o m co m p a re d
as
1 ). T h e r e d u c t io n a t o n e
p r o x im a t e ly A t
t im e
num ber
a lm o s t a
o f c u lt iv a b le
t h e d e n t in o f s e a le d t e e th
th a t o f u n s e a le d
c o n tr o l te e th .
s ig n if ic a n t d if fe r e n c e s w e re f o u n d b e t w e e n
r e p lic a t e
d ilu t io n s
a e r o b ic a lly
and
of
s a m p le s
in c u b a t e d
m ic r o a e r o p h ic a lly
Discussion and conclusion
fro m
an
s e a le d
r e s u lt s o f t h e
c o n fir m w h ic h
th e r e s u lt s it w a s
s ix : m o n th
stu d y
e xte n d
o f th e p r e lim in a r y
c o n je c t u r e d
c ip ie n t o r m o d e r a t e ly
and
s t u d y in
th a t tre a tm e n t o f in
advanced
c a r ie s
w it h
an
o c c lu s a l s e a la n t m a y r e t a r d o r p r e v e n t t h e p r o g re s s o f d e c a y , o r b o th . Th e
d e m o n s t r a t io n
th a t
s e a lin g
o f c a r ie s
in
p it s a n d f is s u r e s is a s a fe a n d b e n e f ic ia l p r o c e d u r e w o u ld e x t e n d th e c lin ic a l u s e f u ln e s s o f a d h e s iv e s
in
are a s
o th e r
th a n
p r e v e n t io n .
H o w
e v e r , b e f o r e t h is is a c c e p t e d a s a r o u t in e p r o c e d u r e , lo n g - t e r m b a c t e r io lo g ic
c lin ic a l s t u d ie s
e v a lu a t io n ,
as
w it h
w e ll a s
a d d it io n a l s t u d ie s
to
th e m e a n c o u n t
d e t e r m in e p o s s ib le c h a n g e s in t h e d e n t in , s h o u ld
f r o m s e a le d le s io n s in c u b a t e d a n a e r o b ic a lly t e n d
b e d o n e . S e a lin g o f c a r io u s p it s a n d f is s u r e s in
e d to b e h ig h e r ( T a b le 2 ).
th e
a n d u n s e a le d le s io n s , a lt h o u g h
T h e p e n e t r a t io n o f t h e c a r io u s le s io n in t o d e n
d e c id u o u s
d e n t it io n
s h o u ld
a ls o
be
e v a l
u a te d .
t in , w it h in t h e p a r a m e t e r s o f th e s t u d y , d id n o t seem
to
v ia b le Th e
s ig n if ic a n t ly
c o u n t fro m
co u n ts
fro m
e ff e c t th e r e m a in in g
th e th e
s e a le d
le s io n
u n s e a le d
to ta l
(T a b le
le s io n s in
3 ).
te e th
w it h a p e n e t r a t io n o f b e t w e e n a f o u r t h t o a h a lf o f t h e d e n t in t e n d e d to b e h ig h e r t h a n t h e t o t a l v ia b le c o u n t f r o m le s io n s in te e th w it h le s s c a r ie s p e n e t r a t io n , b u t t h e r e s u lt s w e r e n o t s ig n if ic a n t s t a t is t ic a lly . Th e
d a ta
o f th e p r e lim in a r y
s tu d y 1 w e re
in
c lu d e d in t h e r e s u lt s o f t h is s t u d y . T h e o n ly d if f e r e n c e in th e m e th o d s o f p r o c e d u r e f o r th e m o re r e c e n t f in d in g s sp ra y
d u r in g
w a s th e u s e
th e
o f a w a te r a n d
in it ia l c a v it y
p r e p a r a t io n ,
a ir in
s t e a d o f a h a n d p i e c e w i t h o u t t h e w a t e r s p r a y . 1,5 Th e
to ta l
num ber
of
o r g a n is m s
c u lt u r e d
fro m
u n s e a le d c a r io u s le s io n s w it h w a t e r a n d a ir s p r a y (n = 1 7 ,
1 0 . 1 x l 0 5/ m g o f c a r i o u s
d e n t in ) w a s e s
s e n t ia lly t h e s a m e a s th e n u m b e r c u lt u r e d w it h o u t th e w a te r s p ra y (n = 9 , o u s d e n t in ). O n r e s u lt s
o f b o th
c o m b in e d .
1 2 . 4 x l 0 5/ m g o f c a r i
t h is b a s is , w e t h o u g h t th a t th e p o r t io n s
o f th e
stu d y
c o u ld
be
The authors wish to thank Mrs. Wilma Schwarze for her ex cellent laboratory assistance. Dr. Handelman is head of the general clinic and director of the internship program, Dr. Buonocore is research coordinator, and Dr. Schoute was an intern at the Eastman Dental Center, Rochester, NY 14603. * Rinn Co., Elgin, 60120. t Ritter Co., Rochester, NY 14611. i S. S. White Div., Pennwalt Corp., Philadelphia, 19102. 1. Handelman, S.L.; Buonocore, M.G.; and Hesek, D.J. A pre liminary report on the effect of fissure sealant on bacteria in den tal caries. J Prosthet Dent 27:390 April 1972. 2. Buonocore, M.G. Adhesive sealing of pits and fissures for caries prevention, with use of ultraviolet light. JADA 80:324 Feb 1970. 3. Buonocore, M.G. Caries prevention in pits and fissures sealed with an adhesive resin polymerized by ultraviolet light: a two-year study of a single adhesive application. JADA 82:1090 May 1971. 4. Handelman, S.L., and Hess, C. Bacterial populations of se lected tooth surface sites. J Dent Res 48:67 Jan-Feb 1969. 5. King, J.B., Jr.; Crawford, J.J.; and Lindahl, R.L. Indirect pulp capping: a bacteriologic study of deep carious dentine in human teeth. Oral Surg 20:663 Nov 1965.
Handelman—Buonocore—Schoute: EFFECT OF FISSURE SEALANT ON BACTERIA ■
1191